The Journal Of The American Medical Association Recently Published An Article Titled: Fill & Download for Free

Head straight to the Journal of the American Medical Informatics Association. You can find the full text of all the articles on PubMed Central (except for the most recent year).This is the principal journal used by researchers in medical informatics, which most certainly includes EMRs.For example, I looked it up just now, and in the July 2015 issue is an article titled "Cost-effectiveness analysis of a hospital EMR system." In the prior issue this one appeared: "Health information technology data standards get down to business: maturation within domains and the emergence of interoperability."If I were you, I would go straight to the journal itself--check your local research library--and simply scan through the contents pages of several issues. You should be able to find lots of promising work. Or, online, go to PubMed central and click on "Advanced" search. On that screen click on "journal" as the search field, and enter the title of the journal. Search on that title, and you should get all the articles in the journal that are included in PubMed Central. Alternatively, just search for your topics of interest. That should still bring up many articles in this journal.

What will ten years of boxing do to your brain?My friend Johnny Walker answered this well, but I thought i would add a little bit of relevant data. Johnny said every fighter has brain damage, it is merely a question of the individual reaction to it.He is, unfortunately, 100% correct.ALL professional, and many amateur, boxers suffer brain injuries, ALL OF THEM, and about 1 in 5 are completely disabled over timeAccording to very reputable studies by highly regarded British researcher Dr. A.H. Roberts, any fighter who fights professionally, has a 100% chance of having brain trauma - but that trauma is not necessarily disabling, nor is it certain to develop into dementia. A fighter’s chances of developing dementia pugilistica (DP), (also called chronic traumatic brain injury (CTBI), and chronic traumatic encephalopathy (CTE)) are approximately 17 out of 100 if the figures consistent with the general population of boxers holds true for him.According to a retrospective, randomized study by Dr. A.H. Roberts regarding CTBI among ex-boxers competing in Great Britain, ALL boxers tested had evidence of chronic brain injury, and approximately 17% had symptoms consistent with DP, which was believed to have been the result of repetitive concussive and/or sub-concussive head traumas, generally over the course of many years.In other words all boxers had some evidence of chronic trauma, and 17 boxers out of 100 suffered dementia as a direct result of fighting. The key appears to be length of time during which repetitive concussive and sub-concussive blows to the head were suffered.According to an explosive new study out of Australia, more damage is done neurologically from sparring than from fights.Let that sink in: more brain trauma long term damage is done to fighters sparring than in actual fights.CREDIT FOR PICTURE TO RINGSIDE BOXINGBoxers, or anyone sparring, are more at risk of brain damage when sparring during training than in actual fights, because of the amount of sheer hours spent sparring, and the cumulative effects of it, according to a research study by a Australian doctor and researcher whose expertise is extremely highly regarded.In a thesis prepared with colleague Michael Wang and published in the British Medical Journal, Dr Peter Lewis described boxing as “a popular activity with many health benefits” but also stressed the dangers, finding that most of the trauma contributing to brain damage boxer sustain happens in training, especially in sparring, rather than in fights.Sparring a bigger risk than real boutsThink about the sheer number of hours fighters spend sparring as opposed to in actual fights, and this is exactly and precisely why more neural trauma occurs during sparring than real fights.And, there is no ring doctor present during sparring, and no mandated sit outs for suspected concussions!Examination, treatment of any suspected trauma, MUST be by qualified physicians and medical experts to prevent permanent harm, or even death, whether in sparring or in actual bouts!CREDIT DOCTORS PETER LEWIS AND MICHAEL WANG, AND THE BRITISH MEDICAL JOURNALHead guards and protective gear do not mitigate the risks of boxingA study, published in Frontiers of Public Health published on July 21, 2014, by the Maryland State Athletic Commission, the Department of Psychiatry, University of Maryland School of Medicine, and other entities, attempted to measure cognitive impairment in amateur boxers, who use protective head gear, from head trauma.Among professional boxers, the majority of injuries occur in the facial area (51%). Additional areas of injury include the hands (17%), eyes (14%), and nose (5%).Evidence from both amateur and professional settings suggested that boxers may suffer from acute cognitive impairment post-injury. Areas of dysfunction noted include delayed memory, information processing and verbal fluency, and spatial and mathematical processing. Dr. Collie Moriarity also found significant slowing in simple and choice reaction time among a group of amateur boxers whose matches were stopped by the referee.Another study by the American Academy of Neurology in 2007, "Does Amateur Boxing Cause Brain Damage?" which appeared in Science Daily on 3 May 2007, found blows to the head in amateur boxing, despite protective headgear, cause brain damage, according to research that presented at the American Academy of Neurology's 59th Annual Meeting in Boston, April 28 -- May 5, 2007.For the study, researchers used lumbar puncture to determine if there were elevated levels of biochemical markers for brain injury in the cerebrospinal fluid (CSF) of 14 amateur boxers. Boxers were tested after a fight and then again three months after rest from boxing. The study also included 10 healthy men who were not athletes.The study found high CSF levels of neuronal and glial markers suggestive of brain damage after a fight. A particular marker for neuronal damage, neurofilament light (NFL), was four times higher in boxers within 10 days of the fight as compared with healthy non-athletes. These increased levels returned to normal after three months rest from boxing for amateurs- but the study stipulated that continued fighting, for years, would cause no return to normality, and progressive degeneration.Significantly, the use of head guards in amateur boxing does not seem to have mitigated the risk of brain injury.The problem is the permanent trauma that head blows bring.One might think that a defensive master like Floyd Mayweather, for instance, is less likely than most to develop pugilistic dementia, but that does not factor in the ferocious sparring sessions he engaged in at Mayweather Gym, and it does not factor in that the critical factor appears to be length of time fighting. The longer one fights, the worse the trauma, and greater liklihood of dehabilitating damage.Indeed, the fighter generally regarded as the ultimate defensive fighter, the finest of all time, Willie Pep, died of pugilistic dementia.Most fighters, despite having brain damage have relatively mild symptoms of chronic brain injuryAccording to the American Medical Association, up to 40 percent of ex-boxers have been found to have symptoms of chronic brain injury. Most of these boxers, about 60%, have relatively mild symptoms. But about 13-15% suffer severe, progressive, impairment. Recent studies have shown that almost all professional boxers (even those without symptoms) have some degree of brain damage.How much impairment do boxers suffer? it depends on the individual, how long they fought, how many blows they took, and a host of factors. One thing is certain, beyond any reasonable doubt as Dr. Max Hietala, MD, PhD, says: "the more you get punched in the head, the greater the possibility of long term damage. Period."A study by the American Academy of Neurology in 2007 found blows to the head in amateur boxing appear to cause brain damage. "This data shows blows to the head in boxing, over time, are associated with neurochemical evidence of brain damage," said study author Max Hietala, MD, PhD, with Sahlgrenska University Hospital, Goteborg, Sweden.What is the truth about boxing, blows to the head, concussions, and cognitive impairment?It appears all too many fighters and trainers are too old school and tough about possible brain trauma, concussions, in sparring sessions.It is vital to note that no distinction is made between Class I and II concussions. That is not a decision for a layman to make, the medical professionals, in particular the Association of Ringside Physicians, mandates treatment, concussion protocols, and treatment preferably by a neurologist or neurosurgeon.The Association of Ringside Physicians has awoken as well to the inherent dangers in sparring, and has recommended not only that any boxer or MMA fighter sustaining a concussion at any time and place be barred from competing, but that a combat sports athlete’s suspension continue until a specialist physician trained in concussion management clears the fighter to return, however long that may take. Specialist physicians trained in concussion management include neurologists, neurosurgeons and primary care sports medicine physicians.https://bjsm.bmj.com/content/bjs...Nor is sparring of any type risk free, even without a concussion! Trauma appears to accumulate, whether an overt injury occurs or not.Dr. Lewis’s work seems to indict that the damage is cumulative, and sparring over the long term creates lasting brain trauma even if you never fight a bout.The cumulative effect of head blows on fighters over time is viciousOne highly regarded scientific study, by the Mild Traumatic Brain Injury Committee, National Football League, and published in the US National Library of Medicine National Institutes of Health Search database, addresses impact biomechanics from boxing punches causing translational and rotational head acceleration. Olympic boxers threw four different punches at an instrumented Hybrid III dummy and responses were compared with laboratory-reconstructed NFL concussions.Head injury criterion (HIC) for boxing punches was lower than for NFL concussions because of shorter duration acceleration. Boxers deliver punches with proportionately more rotational than translational acceleration than in football concussion. Boxing punches have a 65 mm effective radius from the head center of gravity (CG) , which is almost double the 34 mm in football. A smaller radius in football prevents the helmets from sliding off each other in a tackle.Olympic boxers deliver punches with high impact velocity but lower HIC and translational acceleration than in football impacts because of a lower effective punch mass. They cause proportionately more rotational acceleration than in football. Modeling shows that the greatest strain is in the midbrain late in the exposure, after the primary impact acceleration in boxing and football.Interestingly, the hook produced the highest change in hand velocity (11.0 +/- 3.4 m/s) and greatest punch force (4405 +/- 2318 N) with average neck load of 855 +/- 537 N. It caused head translational and rotational accelerations of 71.2 +/- 32.2 g and 9306 +/- 4485 r/s. These levels are consistent with those causing concussion in NFL impacts.In other words, a Olympic class amateur boxer throwing a hook matches any blunt force trauma of a full body NFL impact. A pro boxer, especially a heavyweight hooker such as Mike Tyson, would vastly exceed NFL full body impact with a single left hook.Stop and think about it: one hook from someone like Mike Tyson is more damaging than a full body collision from a 300 pound NFL player launching himself at your head.Another study by the American Academy of Neurology in 2007, "Does Amateur Boxing Cause Brain Damage?" which appeared in Science Daily on 3 May 2007, found blows to the head in amateur boxing cause brain damage, according to research that presented at the American Academy of Neurology's 59th Annual Meeting in Boston, April 28 -- May 5, 2007.For the study, researchers used lumbar puncture to determine if there were elevated levels of biochemical markers for brain injury in the cerebrospinal fluid (CSF) of 14 amateur boxers. Boxers were tested after a fight and then again three months after rest from boxing. The study also included 10 healthy men who were not athletes.The study found high CSF levels of neuronal and glial markers suggestive of brain damage after a fight. A particular marker for neuronal damage, neurofilament light (NFL), was four times higher in boxers within 10 days of the fight as compared with healthy non-athletes. These increased levels returned to normal after three months rest from boxing for amateurs- but the study stipulated that continued fighting, for years, would cause no return to normality, and progressive degeneration.Evidence from amateur and professional settings suggested that boxers may suffer from acute cognitive impairment post-injury. Areas of dysfunction noted include delayed memory, information processing and verbal fluency, and spatial and mathematical processing. Dr. Collie Moriarity also found significant slowing in simple and choice reaction time among a group of amateur boxers whose matches were stopped by the referee.Interest in the chronic consequences of professional boxing is longstanding. In 1928, H. A. Martland published a seminal article titled “Punch Drunk” in which he hypothesized about the relationship between boxing and brain injury.Overtime this condition has also been called dementia pugilistica (DP), chronic traumatic brain injury (CTBI), and chronic traumatic encephalopathy (CTE).Remember Dr. Roberts research: 17 boxers out of 100 suffered dementia as a direct result of fighting.In all studies, the deadliness of boxing cannot be overstated. The force of a professional boxer's fist is equivalent to being hit with a 13-pound bowling ball traveling 20 miles per hour, or about 52 times the force of gravity.According to the Journal of Combative Sport, from January of 1960 to August of 2011, there were 488 boxing-related deaths. The journal attributes 66 percent of these deaths to head, brain or neck injuries; one was attributed to a skull fracture.We can only hope that fighters we see and care about are one of the 83 out of 100 boxers who seem to escape pugilistic dementia, but sadly, only time will tell.The sad truth is, most boxers do not have long, happy, healthy, lives. The ones that escape with their faculties intact, most often do not escape with their money intact, nor are they able to successfully translate their fame into lasting fortune.*********************************************************************************************CREDIT FOR QUOTES AND SCIENTIFIC DATA PRESENTED ABOVE:American Academy of Neurology in 2007, "Does Amateur Boxing Cause Brain Damage?" Science Daily on 3 May 2007The Association of Ringside Physicianshttps://bjsm.bmj.com/content/bjs...Journal of Combative SportFrontiers of Public Health published on July 21, 2014, by the Maryland State Athletic Commission, the Department of Psychiatry, University of Maryland School of MedicineMild Traumatic Brain Injury Committee, National Football League, published in the US National Library of Medicine National Institutes of Health Search databasehttp://sites.edb.utexas.edu/uploads/sites/110/2016/11/Boxing-Lessons-An-Historical-Review-of-Chronic-Head-Trauma.pdfDr. A.H. RobertsOpinion | ARE BLOWS TO HEAD NECESSARY IN BOXING?Dr. Max Hietala, MD, PhD, “A study on Neural Trauma” by the American Academy of Neurology in 2007Drs. Peter Lewis and Michael Wang, and the British Medical JournalTraumatic Brain Injury: Hope Through Research

NO, there are no sensible ways to minimize cerebral injuries cause by boxing.The only certain way to end cerebral injuries in contact sports such as boxing, MMA and football is abolish the sports.As long as men hit each other in the head, there is going to be brain damage.CREDIT PICTURE OF GERALD MCLELLAN TO CHICAGO SUN-TIMESThere is no way to avoid brain damage or CTE if you box, period.Fanboys who tell you that a great defense will prevent brain injury don’t know what they are talking about.The greatest defensive fighter of history is generally considered to be Willie Pep. The Will o’ the Whisp had the best defense of all time. Willie also died with pugilistic dementia from brain injuries.Dementia pugilisticaOne answer said “Ironing out flaws in your stance, footwork, punch execution, and defense—and every day working hard on your balance, agility, speed, strength and stamina” are ways to minimize cerebral injuries.That is completely false. You can be as fast Ali, be as strong as Sonny Liston, be as agile as Mary Lou Retton, have the balance of Shawn Johnson, and be a better defender than Floyd Mayweather and Pernell Whitaker combined - and as long as you get hit in the head at all, you are incurring brain injuries.As to how badly the brain damage will affect you, that varies from individual to individual…Traumatic Brain Injury: Hope Through ResearchAccording to an explosive new study out of Australia, more damage is done neurologically from sparring than from fights.New research indicates any time you get hit in the head, you suffer neural damage. And not only does it include sparring, sparring appears to cause more damage than the fights themselves because so many more blows are exchanged in sparring.Let that sink in: more brain trauma long term damage is done to fighters sparring than in actual fights.Indeed, boxers are more at risk of brain damage when sparring during training than in actual fights, because of the amount of sheer hours spent sparring, and the cumulative effects of it, according to a research study by a Australian doctor and researcher whose expertise is extremely highly regarded.In a thesis prepared with colleague Michael Wang and published in the British Medical Journal, Dr Peter Lewis described boxing as “a popular activity with many health benefits” but also stressed the dangers, finding that most of the trauma contributing to brain damage boxer sustain happens in training, especially in sparring, rather than in fights.Sparring a bigger risk than real boutsIt appears all too many fighters and trainers are too old school and tough about possible brain trauma, concussions, in sparring sessions.Think about the sheer number of hours fighters spend sparring as opposed to in actual fights, and this is exactly and precisely why more neural trauma occurs during sparring than real fights.Routine sparring in boxing can affect brain performanceAnd, there is no ring doctor present during sparring, and no mandated sit outs for suspected concussions!Examination, treatment of any suspected trauma, MUST be by qualified physicians and medical experts to prevent permanent harm, or even death, whether in sparring or in actual bouts!CREDIT DOCTORS PETER LEWIS AND MICHAEL WANG, AND THE BRITISH MEDICAL JOURNALThe longer you box, the more blows you take, in sparring or in fights, the worse the damage isOne might think that a defensive master like Floyd Mayweather, for instance, is less likely than most to develop pugilistic dementia, but that does not factor in the ferocious sparring sessions he engaged in at Mayweather Gym, and it does not factor in that the critical factor appears to be length of time fighting. The longer one fights, the worse the trauma, and greater liklihood of dehabilitating damage.Indeed, the fighter generally regarded as the ultimate defensive fighter, the finest of all time, Willie Pep, died of pugilistic dementia.According to the American Medical Association, up to 40 percent of ex-boxers have been found to have symptoms of chronic brain injury. Most of these boxers, about 60%, have relatively mild symptoms. But about 15–20% suffer severe, progressive, impairment. Recent studies have shown that almost all professional boxers (even those without symptoms) have some degree of brain damage.Dementia Pugilistica.How much impairment do boxers suffer?It depends on the individual, how long they fought, how many blows they took, and a host of factors. One thing is certain, beyond any reasonable doubt as Dr. Max Hietala, MD, PhD, says: "the more you get punched in the head, the greater the possibility of long term damage. Period."But what about the effects of boxing over time?What is the truth about boxing, blows to the head, and cognitive impairment?The cumulative effect of head blows in boxing is vicious.One highly regarded scientific study, by the Mild Traumatic Brain Injury Committee, National Football League, and published in the US National Library of Medicine National Institutes of Health Search database, addresses impact biomechanics from boxing punches causing translational and rotational head acceleration. Olympic boxers threw four different punches at an instrumented Hybrid III dummy and responses were compared with laboratory-reconstructed NFL concussions.Head injury criterion (HIC) for boxing punches was lower than for NFL concussions because of shorter duration acceleration. Boxers deliver punches with proportionately more rotational than translational acceleration than in football concussion. Boxing punches have a 65 mm effective radius from the head center of gravity (CG) , which is almost double the 34 mm in football. A smaller radius in football prevents the helmets from sliding off each other in a tackle.Olympic boxers deliver punches with high impact velocity but lower HIC and translational acceleration than in football impacts because of a lower effective punch mass. They cause proportionately more rotational acceleration than in football. Modeling shows that the greatest strain is in the midbrain late in the exposure, after the primary impact acceleration in boxing and football.Interestingly, the hook produced the highest change in hand velocity (11.0 +/- 3.4 m/s) and greatest punch force (4405 +/- 2318 N) with average neck load of 855 +/- 537 N. It caused head translational and rotational accelerations of 71.2 +/- 32.2 g and 9306 +/- 4485 r/s. These levels are consistent with those causing concussion in NFL impacts.In other words, a Olympic class amateur boxer throwing a hook matches any blunt force trauma of a full body NFL impact. A pro boxer, especially a heavyweight hooker such as Mike Tyson, would vastly exceed NFL full body impact with a single left hook.Stop and think about it: one hook from someone like Mike Tyson is more damaging than a full body collision from a 300 pound NFL player launching himself at your head.Twelve Years of National Football League Concussion DataInterest in the chronic consequences of professional boxing is longstanding. In 1928, H. A. Martland published a seminal article titled “Punch Drunk” in which he hypothesized about the relationship between boxing and brain injury.Overtime this condition has also been called dementia pugilistica (DP), chronic traumatic brain injury (CTBI), and chronic traumatic encephalopathy (CTE).Remember Dr. Roberts research: 17 boxers out of 100 suffered dementia as a direct result of fighting.Head guards and protective gear do not mitigate the risks of boxingA study, published in Frontiers of Public Health published on July 21, 2014, by the Maryland State Athletic Commission, the Department of Psychiatry, University of Maryland School of Medicine, and other entities, attempted to measure cognitive impairment in amateur boxers, who use protective head gear, from head trauma.Among professional boxers, the majority of injuries occur in the facial area (51%). Additional areas of injury include the hands (17%), eyes (14%), and nose (5%).Evidence from both amateur and professional settings suggested that boxers may suffer from acute cognitive impairment post-injury. Areas of dysfunction noted include delayed memory, information processing and verbal fluency, and spatial and mathematical processing. Dr. Collie Moriarity also found significant slowing in simple and choice reaction time among a group of amateur boxers whose matches were stopped by the referee.Another study by the American Academy of Neurology in 2007, "Does Amateur Boxing Cause Brain Damage?" which appeared in Science Daily on 3 May 2007, found blows to the head in amateur boxing, despite protective headgear, cause brain damage, according to research that presented at the American Academy of Neurology's 59th Annual Meeting in Boston, April 28 -- May 5, 2007.For the study, researchers used lumbar puncture to determine if there were elevated levels of biochemical markers for brain injury in the cerebrospinal fluid (CSF) of 14 amateur boxers. Boxers were tested after a fight and then again three months after rest from boxing. The study also included 10 healthy men who were not athletes.The study found high CSF levels of neuronal and glial markers suggestive of brain damage after a fight. A particular marker for neuronal damage, neurofilament light (NFL), was four times higher in boxers within 10 days of the fight as compared with healthy non-athletes. These increased levels returned to normal after three months rest from boxing for amateurs- but the study stipulated that continued fighting, for years, would cause no return to normality, and progressive degeneration.Significantly, the use of head guards in amateur boxing does not seem to have mitigated the risk of brain injury.Does Amateur Boxing Cause Brain Damage?In all studies, the deadliness of boxing cannot be overstated.Interest in the chronic consequences of professional boxing is longstanding. In 1928, H. A. Martland published a seminal article titled “Punch Drunk” in which he hypothesized about the relationship between boxing and brain injury.The force of a professional boxer's fist is equivalent to being hit with a 13-pound bowling ball traveling 20 miles per hour, or about 52 times the force of gravity.According to the Journal of Combative Sport, from January of 1960 to August of 2011, there were 488 boxing-related deaths. The journal attributes 66 percent of these deaths to head, brain or neck injuries; one was attributed to a skull fracture.We can only hope that fighters we see and care about are one of the roughly 8 out of 10 who seem to escape pugilistic dementia, but sadly, only time will tell.In addition to brain damage, you can dieAt least 500 boxers have died in the ring or shortly thereafter from ring related injury.BOXING : BOXERS DYING OR LEFT SERIOUSLY INJURED AFTER FIGHTSAt least 13 fighters a year die from head trauma.Each year, 13 boxers on average die in the ringAnd, of course, if you survive, you have one chance in five of going insane.Dementia Pugilistica.Brain damage occurs in amateur boxers as well as professionals.Studies show that the risk of CTE is present in amateur boxing just as with professional boxing.The bottom line is when you engage in an activity that includes being hit in the head, you are incurring neural trauma, period.Is Traumatic Brain Injury Preventable in Amateur Boxing Competition?Is there any sensible way to minimize cerebral damage? Do not get hit in the head.Research has long shown that head trauma, which is something no boxer can avoid since they get punched in the head. Brain damage is irreversible. The extent of individual disability differs from fighter to fighter, but every single one suffers neural trauma. Brain cells cannot repair themselves (as can cells in other parts of the body), so damaged neurons stay damaged neurons.Get hit, get brain injured. 17 to 20% of boxers end up with pugilistic dementia and other problems.Does Boxing Cause Brain Damage?CREDIT TO:American Academy of Neurology in 2007, Does Amateur Boxing Cause Brain Damage?" appearing in Science Daily on 3 May 2007BOXING : BOXERS DYING OR LEFT SERIOUSLY INJURED AFTER FIGHTSBritish Medical Journel Dr. Peter WangDementia pugilisticaDementia Pugilistica.Does Amateur Boxing Cause Brain Damage?Does Boxing Cause Brain Damage?Each year, 13 boxers on average die in the ringIs Traumatic Brain Injury Preventable in Amateur Boxing Competition?Journal of Combative Sport, November 2011 issuePunch Drunk by H. A. MartlandRoutine sparring in boxing can affect brain performanceTraumatic Brain Injury: Hope Through ResearchTwelve Years of National Football League Concussion Data